Acute Epiglottitis

What Is Acute Epiglottitis?

Acute epiglottitis is a sudden swelling up of a cartilage flap located just behind the tongue. When healthy, this flap, called an epiglottis, blocks food and drink from descending the trachea or windpipe into the lungs whenever you swallow. An inflamed epiglottis can also prevent air from entering or leaving the trachea, making it difficult to breathe. Acute epiglottitis is considered a life-threatening condition, requiring emergency medical treatment.

If you or a loved one experience a sudden onset of severe breathing difficulties, seek care at the nearest emergency medical facility. If you suspect that you are at risk for a respiratory disorder, make an appointment with a member of the Baptist Health pulmonology team.

Signs & Symptoms

Until recently, children ages 3 to 5 were most likely to develop acute epiglottitis. With the widespread implementation of Hib vaccinations, risk shifted to older children and adults. The symptoms for acute epiglottitis vary somewhat for these two groups, with considerable overlap. The following symptoms are common to both:

  • Coughing
  • Difficulty breathing
  • Drooling
  • Fever
  • Pain on swallowing
  • Red, sore throat
  • Stridor (a wheezy, high-pitched sound on in-breaths)

Children with acute epiglottitis are often irritable and tend to sit up straight or rock back and forth to reduce airway constriction. Adults and older children will speak in strained or muffled tones.

Respiratory specialists have developed a shorthand means of defining the symptoms of acute epiglottitis known as “the 4 Ds”:

  • Distress: Troubled breathing
  • Drooling: The loss of saliva outside the mouth
  • Dysphagia: Problems swallowing
  • Dysphonia: Difficult or odd-sounding speech

Causes

Infection is the primary cause of acute epiglottitis. Several different pathogens may be involved:

  • Hib: Hib is an abbreviation of Haemophilus influenzae type B. This bacterium is the most common cause of epiglottitis.
  • Non-Hib bacteria: Other bacteria, including Streptococcus pneumoniae, can be a source of epiglottitis.
  • Viral infections: Some viruses can cause epiglottitis, including the chickenpox and herpes simplex viruses.
  • Fungal infections: Fungal infections can trigger epiglottitis. Individuals with depleted immune systems are especially vulnerable.

Certain types of throat injury can also lead to epiglottitis. Behaviors resulting in throat injury include:

  • Smoking
  • Drinking hot liquids
  • Receiving a blow to the throat
  • Experiencing a chemical burn
  • Undergoing chemotherapy

To the extent that epiglottitis is caused by airborne pathogenic agents, it can be contagious.

Risk Factors

As is the case with most medical conditions, some persons are more at risk than others. Factors that can increase the likelihood of contracting epiglottitis include:

  • Age: The level of risk for age groups varies with vaccination status. Young children are most vulnerable prior to being vaccinated for Hib. The risk shifts to older children and adults for those who have been vaccinated.
  • Being unvaccinated for Hib: Young children who have not been vaccinated for Hib, especially those from 3 to 5 years of age, stand a greater chance of developing epiglottitis than those who are vaccinated.
  • Having a weakened immune system: A depleted immune system can reduce your body’s ability to throw off infections like the ones that cause epiglottitis.

Medical data also suggest that men are more vulnerable to epiglottitis than women.

Diagnosis

Because the initial care for epiglottitis is often delivered in an emergency setting, the medical team’s first step is to ensure that airways are open, and that oxygen is reaching the patient’s lungs. A more thorough examination takes place only after breathing has been stabilized. Steps include:

  • A throat exam: The medical team will examine the patient’s throat to identify the cause of the breathing problem. This is often done with a laryngoscope, a thin, flexible tube with fiber-optic lighting and a tiny camera that can be inserted through the nose to visually inspect the epiglottis and windpipe.
  • An imaging test: An X-ray or computerized tomography (CT) scan can sometimes identify a swollen epiglottis, which will appear on screen as a small wedge at the top of the throat.
  • A throat culture: If the Hib bacterium is present, the medical team can identify it by wiping the epiglottis with a cotton swab and analyzing the sample in a lab.
  • Bloodwork: A blood sample can assist in the identification of any further pathogens circulating in the body.

Treatment Options

Epiglottitis is a life-threatening condition that requires treatment in an emergency healthcare facility. The medical team will focus first on making certain that the patient is receiving adequate levels of oxygen. This can be done by means of:

  • Intubation: Intubation is the insertion of an air tube into the throat that bypasses the inflamed epiglottis.
  • Oxygen delivery: If the windpipe is at least partially open, oxygen can be delivered through a mask worn by the patient.
  • A needle cricothyroidotomy: In more extreme cases, a physician will insert a needle directly into the trachea below the epiglottis, to deliver oxygen directly to the lungs. This is done only when the swollen epiglottis has completely stopped the movement of air in and out of the body.

Your physician will begin treating you for cause only after you’re receiving sustainable levels of oxygen. He or she will prescribe antibiotic, antiviral, or antifungal medications for an infection. The treatment provided for a throat injury will depend on the nature of the injury and the expected time it takes the damaged tissues to heal.

Acute epiglottitis should be taken seriously. In its most severe form, it can lead to death. If emergency care is provided in time, the medical outlook is positive. Patients generally spend about a week in the hospital, finishing their recovery at home.

Prevention

It’s not possible to completely eliminate the risk of epiglottitis, but there are several steps that you can take to put the odds more in your favor:

  • Get vaccinated: Make sure that you’ve received all your recommended vaccinations, including Hib. This is particularly important for young children, who are susceptible to epiglottitis and whose immune systems are still maturing.
  • Avoid infections: Because the pathogens that cause epiglottitis can be transmitted through the air by coughing and sneezing, practice caution when interacting with persons who show signs of being ill.
  • Protect your throat: Avoid activities such as smoking that can cause unwanted and unnecessary injury to the throat.
  • Wash your hands regularly: Good hygiene matters. Wash your hands after bathroom use or contact with others, using warm, soapy water.

Learn More About Acute Epiglottitis

Acute epiglottitis is a potentially life-threatening medical condition typically resulting from infection or certain forms of injury. Prompt medical care is recommended. Find a local doctor near you today.

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